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    <title>西雅图心绞痛量表</title>
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	<div style="margin:20px 20px 0px 200px; text-align:center"><h2>西雅图心绞痛量表</h2></div>
	
	<div id="patient" style="margin:20px 20px 0px 200px; border: dashed 1px  #777">
		<form action="PatientFormEdit" method="post">
			<input type="hidden" name="pfId" value="${pfId}" /> 
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				<b>1.过去4周内，由于胸痛、胸部紧榨感和心绞痛所致下列各项受限程度：</b>
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			    	<span style="width:120px"></span>
			    	<span style="width:80px; text-align:center">重度受限</span>
			    	<span style="width:80px; text-align:center">中度受限</span>
			    	<span style="width:80px; text-align:center">轻度受限</span>
			    	<span style="width:80px; text-align:center">稍受限</span>
			    	<span style="width:80px; text-align:center">不受限</span>
			    	<span style="width:120px; text-align:center">因其他原因受限</span>
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			    	<span style="width:120px">自行穿衣</span>
			    	<s:radio name="b94" list='#{1:"", 2:"",3:"",4:"",5:""}' value="%{blankList[0].intValue}"  cssClass="radioItem" theme="simple"/>
			    	<input class="txt" type="text" name="b95" value="${blankList[1].strValue}" />
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			    	<span style="width:120px">室内散步</span>
			    	<s:radio name="b96" list='#{1:"", 2:"",3:"",4:"",5:""}' value="%{blankList[2].intValue}" cssClass="radioItem" theme="simple"/>
			    	<input class="txt" type="text" name="b97" value="${blankList[3].strValue}" />
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			    	<span style="width:120px">淋&nbsp; 浴</span>
			    	<s:radio name="b98" list='#{1:"", 2:"",3:"",4:"",5:""}' value="%{blankList[4].intValue}" cssClass="radioItem" theme="simple"/>
			    	<input class="txt" type="text" name="b99" value="${blankList[5].strValue}" />
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			    	<span style="width:120px">爬小山或上一段楼梯（不停）</span>
			    	<s:radio name="b100" list='#{1:"", 2:"",3:"",4:"",5:""}' value="%{blankList[6].intValue}" cssClass="radioItem" theme="simple"/>
			    	<input class="txt" type="text" name="b101" value="${blankList[7].strValue}" />
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			    	<span style="width:120px">户外活动或提携杂物</span>
			    	<s:radio name="b102" list='#{1:"", 2:"",3:"",4:"",5:""}' value="%{blankList[8].intValue}" cssClass="radioItem" theme="simple"/>
			    	<input class="txt" type="text" name="b103" value="${blankList[9].strValue}" />
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			    	<span style="width:120px">轻快步行一条街段</span>
			    	<s:radio name="b104" list='#{1:"", 2:"",3:"",4:"",5:""}' value="%{blankList[10].intValue}" cssClass="radioItem" theme="simple"/>
			    	<input class="txt" type="text" name="b105" value="${blankList[11].strValue}" />
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			    	<span style="width:120px">慢&nbsp;  跑</span>
			    	<s:radio name="b106" list='#{1:"", 2:"",3:"",4:"",5:""}' value="%{blankList[12].intValue}" cssClass="radioItem" theme="simple"/>
			    	<input class="txt" type="text" name="b107" value="${blankList[13].strValue}" />
			    </div>
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			    	<span style="width:120px">提起或移动重物</span>
			    	<s:radio name="b108" list='#{1:"", 2:"",3:"",4:"",5:""}' value="%{blankList[14].intValue}" cssClass="radioItem" theme="simple"/>
			    	<input class="txt" type="text" name="b109"  value="${blankList[15].strValue}"/>
			    </div>
			    
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			    	<span style="width:120px">剧烈运动（如游泳和打网球）</span>
			    	<s:radio name="b110" list='#{1:"", 2:"",3:"",4:"",5:""}' value="%{blankList[16].intValue}" cssClass="radioItem" theme="simple"/>
			    	<input class="txt" type="text" name="b111"  value="${blankList[17].strValue}"/>
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			<b>2. 与4周前比较，作最大强度的活动时，胸痛、胸部紧榨感和心绞痛的发作情况：</b>
				<div class="doc"><span>
				<s:radio name="b112" list='#{1:"⑴明显增加", 2:"⑵轻微增加",3:"⑶相同 ",4:"⑷轻微减少",5:"⑸明显减少"}' value="%{blankList[18].intValue}" cssClass="choiceRadio"/>                 
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			<b>3. 过去4周内，胸痛、胸部紧榨感和心绞痛的平均发作次数：</b>
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				<s:radio name="b113" list='#{1:"⑴大于等于4次/日", 2:"⑵1～3次/日",3:"⑶大于等于3次/周 ",4:"⑷1～2次/周",5:"⑸小于1次/周", 6:"⑹无发作"}' value="%{blankList[19].intValue}" cssClass="choiceRadio"/>                 
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			<b>4. 过去4周内，因胸痛、胸部紧榨感和心绞痛服用硝基药物（如硝酸甘油）和或者救心丸平均次数：</b>
				<div class="doc"><span>
				<s:radio name="b114" list='#{1:"⑴大于等于4次/日", 2:"⑵1～3次/日",3:"⑶大于等于3次/周 ",4:"⑷1～2次/周",5:"⑸小于1次/周", 6:"⑹无发作"}' value="%{blankList[20].intValue}" cssClass="choiceRadio"/>                 
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			<b>5. 因胸痛、胸部紧榨感和心绞痛遵医嘱服药带来的烦恼：</b>
				<div class="doc"><span>
				<s:radio name="b115" list='#{1:"⑴严重", 2:"⑵中度",3:"⑶轻微",4:"⑷极少",5:"⑸无", 6:"⑹医生未给药"}' value="%{blankList[21].intValue}" cssClass="choiceRadio"/>                 
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			<b>6. 对治疗胸痛、胸部紧榨感和心绞痛的各种措施的满意程度：</b>
				<div class="doc"><span>
				<s:radio name="b116" list='#{1:"⑴不满意", 2:"⑵大部分不满意",3:"⑶部分满意",4:"⑷大部分满意",5:"⑸高度满意"}' value="%{blankList[22].intValue}" cssClass="choiceRadio"/>                 
				</span></div>
			</div>
	
			<div class="doc">
			<b>7. 对医生就胸痛、胸部紧榨感和心绞痛的解释满意程度：</b>
				<div class="doc"><span>
				<s:radio name="b117" list='#{1:"⑴不满意", 2:"⑵大部分不满意",3:"⑶部分满意",4:"⑷大部分满意",5:"⑸高度满意"}' value="%{blankList[23].intValue}" cssClass="choiceRadio"/>                 
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			<b>8. 总的来说，对目前胸痛、胸部紧榨感和心绞痛的治疗满意程度：</b>
				<div class="doc"><span>
				<s:radio name="b118" list='#{1:"⑴不满意", 2:"⑵大部分不满意",3:"⑶部分满意",4:"⑷大部分满意",5:"⑸高度满意"}' value="%{blankList[24].intValue}" cssClass="choiceRadio"/>                 
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			<b>9. 过去4周内，因胸痛、胸部紧榨感和心绞痛影响生活乐趣的程度：</b>
				<div class="doc"><span>
				<s:radio name="b119" list='#{1:"⑴严重", 2:"⑵中度",3:"⑶轻微",4:"⑷极少",5:"⑸无影响"}' value="%{blankList[25].intValue}" cssClass="choiceRadio"/>                 
				</span></div>
			</div>
	                        
	        <div class="doc">            
			<b>10. 在您的未来生活中如果还有胸痛、胸部紧榨感或心绞痛，您会感觉怎样？</b>
				<div class="doc"><span>
				<s:radio name="b120" list='#{1:"⑴不满意", 2:"⑵大部分不满意",3:"⑶部分满意",4:"⑷大部分满意",5:"⑸高度满意"}' value="%{blankList[26].intValue}" cssClass="choiceRadio"/>                 
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			<b>11. 对心脏病发作和突然死亡的担心程度：</b>
				<div class="doc"><span>
				<s:radio name="b121" list='#{1:"⑴一直担心", 2:"⑵经常担心",3:"⑶有时担心",4:"⑷很少担心",5:"⑸绝不担心"}' value="%{blankList[27].intValue}" cssClass="choiceRadio"/>                 
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			<div align="center" style="margin-top:20px">
				<input type="submit" value="保存当前">
				<input type="button" value="保存并进入下一步">
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